The use of implants to affix tissue grafts to bone is well known in the orthopedic arts. Common procedures in which such implants are used include, for example, the repair of rotator cuff tears, the repair of torn ligaments in the knee, among others. In these procedures, a socket is drilled or punched in the bone at the attachment site and a graft is secured to the bone using an implant placed in the socket. The graft may be secured to the implant by sutures, or, alternatively, an end of the graft may be placed in the socket and secured directly by an implant. Various devices, systems, and methods for attaching soft tissue grafts, such as ligaments and tendons, to boney surfaces are described in detail in U.S. Pat. No. 9,226,817 and U.S. Pub. No. 2016/0157,852 A1, both to Dougherty et al., as well as the following co-pending Continuation-in-Part applications that claim priority thereto: U.S. Ser. Nos. 15/256,815, 15/256,838, and 15/256,945, all filed Sep. 6, 2016. The contents of these prior disclosures are hereby incorporated by reference herein in their entirety.
In certain procedures, the implant-receiving socket must be formed in the bone by drilling rather than punching. In these cases, a twist drill bit is conventionally mounted in to a powered surgical drilling device. Examples of such configurations are commercially available under tradenames such as the Arthrex 600 Large Bone Power System or the Arthrex 300 Small Bone Power System by Arthrex, Inc. (Naples, Fla.). In addition, Conmed Corporation (Utica, N.Y.) offers a drill chuck that may be removably mounted in an endoscopic shaver handpiece. Such a device, known in commercial circles as a “Thorne Chuck”, is a reusable device into which conventional twist drills may be mounted. In all of these conventional drilling systems, the devices are reusable, thereby necessitating cleaning and sterilization between uses, a requirement that has significant impact on cost and constrains scheduling. Additionally, the use of these reusable devices presents opportunities for infection if/when the devices are not cleaned and sterilized properly.
A further limitation of commercially available drilling devices and systems relates to the sockets produced. To that end, many of the drilling devices and systems of the prior art are generally only able to produce sockets that are coaxial with the driving device axis of rotation. Accordingly, specialized systems have been developed that allow the formation of off-axis holes in boney surfaces through the use of a drill driven by a flexible member that transmits torque from the driving handpiece. Illustrative examples of such “off-axis” devices include, for example, the Pivot Phoenix system by Stryker, Inc. (Kalamazoo, Mich.), which is used for drilling small diameter holes in microfracture procedures. The location and angle of entry of the drill into the bone is determined by a separate guide through which the drill is introduced. Unfortunately, using such devices is difficult for the surgeon since he must hold both the guide and the drill while a third hand is required to hold the endoscope. In many cases, the guide distal end will shift during use resulting in misplacement and/or misalignment of the resulting drilled hole. Indeed, when standard drilling devices are used to produce an off-axis hole, the drill must have a flexible torque-transmitting drive portion. Furthermore, a separate guiding device is required to direct the distal drilling portion to the desired location at the desired angular orientation. The use of these guiding devices is problematic for the surgeon as it requires controlling both the powered drilling device and the guiding device.
In the above-cited U.S. Pat. No. 9,226,817 to Dougherty et al., a disclosure that is incorporated by reference herein in its entirety, implant systems and methods are described that allow an implant to be placed in a location(s) that cannot be reached by conventional procedures, e.g., using a rigid linear placement system. The anchor placement systems described by Dougherty et al. include a distal portion that may be angularly offset from the proximal, torque-producing portion(s) of the system. As discussed in detail therein, there is a significant need in the art for drilling systems that can produce the required “off axis” sockets. Such “off axis” sockets may also be utilized for the placement of suture-based “soft” anchors that need not be threaded into the socket, but rather may be easily inserted into the socket and then deployed by applying tension to sutures attached to the anchor. Illustrative examples of such anchoring systems include, but are not limited to, the Draw Tight Suture Anchors by Parcus Medical, Inc. (Sarasota, Fla.), and the Y-Knot RC All-Suture Anchor System by Conmed Corporation (Utica, N.Y.).
Co-pending U.S. patent application Ser. No. 15/142,120 filed Apr. 29, 2016, also to Dougherty et al. and also incorporated by reference herein, describes an improved method for ACL and PCL repair and reconstruction by means of interference screw fixation using implant placement systems that have a distal portion that is angularly offset from the torque-producing proximal portion. The '120 disclosure further describes forming the requisite tunnels for the grafts using a drilling device that is powered by an arthroscopic shaver handpiece and that includes a distal portion angularly offset from the proximal torque-producing portion of the device.
While the Dougherty systems and methods constitute significant advances in the fields of endoscopic and arthroscopic surgery, particularly in the area of ligament and tendon repair, there nevertheless remains a clear need for additional shaver handpiece-powered disposable endoscopic drilling devices. For example, while an endoscopic drilling device of a rigid linear construction would have significant utility, a device having a fixed angular offset between the distal drilling portions of the device and the more proximal portions would allow surgeons to form tunnels and sockets in locations in which an equivalent rigid linear device could not. Still more desirable is a drilling device in which the distal portion may be angularly offset by the surgeon at the time of use, wherein the angular offset may be optimized by the surgeon to suit the procedure to be performed.
Numerous other surgical procedures also involve the drilling of holes in boney surfaces and solid tissues. For example, microfracture is commonly used to treat damaged articular cartilage. The procedure generally involves drilling or punching a pattern of holes into a properly prepared boney surface. Current techniques use a microfracture awl that is driven into the bone using a mallet, or, alternatively, use specialized drilling devices such as the PowerPicks by Arthrex, Incorporated (Naples, Fla.). However, such techniques have significant drawbacks, primarily stemming from difficulties in accessing certain locations and in consistently producing holes with the desired geometry. With regard to the latter, access to locations that are not in line with the axis of the awl is frequently required. In such cases, it becomes necessary to drive into the surface an awl having an off-axis pointed distal tip. Such techniques are rife with problems, including the inefficient application of the mallet, which poses the risk of injury to the surgeon's hands and frequently results in “skiving”, a condition in which the awl's pointed distal end does not cleanly penetrate the surface but rather skids along the surface, producing a groove. In addition, many of the conventional off-axis devices, such as the PowerPick device, have an off-axis distal treatment portion formed at a fixed angle to the axis. This fixed arrangement is frequently problematic, particularly when the maximum formed angle of the devices is insufficient or not suitable for allowing the drilling of a hole having an axis substantially normal to the boney surface, a condition that greatly enhances the likelihood of successful treatment.
In view of the aforementioned problems and deficiencies present in the arthroscopic and endoscopic arts, there remains a need for a microfracture drill that may be powered by a shaver handpiece and that, in operation, does not require the use of a separate guiding device to produce off-axis holes. There is further a need in the art for such a device to include a distal portion that may be bent and rebent by the surgeon to an optimum offset so as to produce an array of holes having axes substantially normal to the boney surface. The present invention addresses both of these needs.